197602857-12-31-2024-29-AS-KHEN-DCH2BK-20241231161517

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602857
Report Date: 12/31/2024
Date Signed: 12/31/2024 09:38:23 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/20/2023 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20231220105331

FACILITY NAME:	ROYAL GARDEN		FACILITY NUMBER:	197602857
ADMINISTRATOR:	KIGEL, ALEKSANDR		FACILITY TYPE:	740
ADDRESS:	6159 ATOLL AVE		TELEPHONE:	(818) 909-0210
CITY:	VALLEY GLEN	STATE: CA	ZIP CODE:	91401
CAPACITY:	6	CENSUS: 4	DATE:	12/31/2024
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	William Vegara, staff		TIME COMPLETED:	09:50 AM

ALLEGATION(S):

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Staff handled resident in a rough manner which resulted in bruising
Staff did not provide adequate food service
Untrained staff
Staff confined resident to their room
Staff do not provide drinking water for resident
Staff did not meet resident’s toileting needs
Staff did not provide resident with clean bed sheets

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced subsequent complaint visit to this facility to deliver findings. At 9:05 a.m., the LPA met with staff and explained the reason for the visit. At 9:11 a.m., the LPA spoke with the Licensee, Sophia Labendze over the telephone. The Licensee authorized staff, William Vegara to sign the report.

During the initial visit conducted on 12/28/2023 between 12:30 p.m. and 2:30 p.m., LPA Peraldi conducted a physical plant tour and conducted interviews with two (2) staff, three (3) residents and one (1) resident’s family member. During the initial visit, the LPA also obtained copies of pertinent documents. During a subsequent visit conducted on 3/13/2024 between 12:26 p.m. and 2:30 p.m., LPA Peraldi conducted a physical plant tour and conducted interviews with the Licensee, one (1) resident and one (1) resident’s family member.
Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 29-AS-20231220105331

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROYAL GARDEN	FACILITY NUMBER: 197602857
	VISIT DATE: 12/31/2024

NARRATIVE

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Regarding the allegation:1.) Staff handled resident in a rough manner which resulted in bruising. It was alleged that staff handled Resident #1 (R1) in a rough manner when transferring R1 to R1’s bed which resulted in bruising. Interviews conducted with staff and the Licensee revealed that staff are very careful when transferring R1 in and out of bed. The Licensee stated that she is not sure of the origins of R1’s bruises. The Licensee stated that staff reported the bruises to her. The Licensee believes that R1’s bruises could be cause by R1’s medication. The Licensee stated that she has tried to speak to R1’s physician regarding R1’s bruises and skin condition but R1’s representative did not disclose R1’s medical information to the Licensee. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Regarding the allegation: 2.) Staff did not provide adequate food service. It was alleged that the staff serve food that is of poor quality and of low nutrition value. During physical plant tours conducted on 12/28/2023 and 3/13/2024, the LPA observed sufficient amount of perishable and non-perishable food. The LPA observed sufficient number of fruits and vegetables being served to the residents. Resident interviews did not reveal any concerns regarding the food being served. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Regarding the allegation: 3.) Untrained staff. During the course of the investigation, the LPA conducted a record review of personnel records and found all files in order. The LPA observed training documentation showing required training completed. Additionally, on 5/22/2024, LPA Urena conducted an annual visit and reviewed personnel records including first aid/CPR training, and the appropriate training and found all files were in order. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Continued on LIC 9099-C.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231220105331

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROYAL GARDEN	FACILITY NUMBER: 197602857
	VISIT DATE: 12/31/2024

NARRATIVE

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Regarding the allegation: 4.) Staff confined resident to their room. It was alleged that R1 is confined to R1’s room. Interviews conducted with staff and the Licensee revealed that R1’s family member/ representative visits R1 every day and stays in R1’s room. Staff stated that they listen to R1’s family member/ representative routine since they do not want issues with R1’s family member/ representative. Staff stated that R1 and other residents are not confined to their rooms as they request to be in the living area or outdoor areas. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Regarding the allegation:5.) Staff do not provide drinking water for resident. During physical plant tours conducted on 12/28/2023 and 3/13/2024, the LPA observed drinkable water available to the residents in care. Resident interviews did not reveal any concerns regarding the water. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Regarding the allegation:6.) Staff did not meet resident’s toileting needs. Resident interviews did not reveal any concerns regarding staff not meeting their toileting needs. Staff interviews revealed that staff change residents diapers every 2-3 hours or when needed. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Regarding the allegation: 7.) Staff did not provide resident with clean bed sheets. During physical plant tours conducted on 12/28/2023 and 3/13/2024, the LPA observed residents’ bedrooms with clean linens. Staff interviews revealed that staff wash residents bed sheets weekly or as needed. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024

LIC9099 (FAS) - (06/04)

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